2022 年第 12 期 第 17 卷

氟马西尼拮抗瑞马唑仑全身麻醉术后残余镇静作用的临床观察

Clinical observation of flumazenil antagonizing the residual sedative effect of remimazolam after general anesthesia

作者：安璐 刘颖 崔秀花 王惠军 王古岩

英文作者：An Lu Liu Ying Cui Xiuhua Wang Huijun Wang Guyan

单位：首都医科大学附属北京同仁医院麻醉科，北京100730

英文单位：Department of Anesthesiology Beijing Tongren Hospital Capital Medical University Beijing 100730 China

关键词：氟马西尼；瑞马唑仑；五官科手术；全身麻醉；喉罩

英文关键词：Flumazenil;Remimazolam;Ophthalmologyandotorhinolaryngologysurgery;Generalanesthesia;Laryngealmask

• 摘要：

• 目的  观察氟马西尼用于五官科手术喉罩全身麻醉患者术后拮抗瑞马唑仑残余镇静作用的有效性和安全性。方法  选取首都医科大学附属北京同仁医院2021年7月至2022年7月收治的择期行喉罩全身麻醉的眼（玻璃体切割术）、耳（鼓室成形术）、鼻（鼻内窥镜下鼻窦开放术）科手术患者80例，采用随机数字表法将患者分为氟马西尼组和对照组，每组40例。2组均采用瑞马唑仑诱导和维持的喉罩全身麻醉。氟马西尼组在术毕停用瑞马唑仑后予氟马西尼静脉推注；对照组术毕停用瑞马唑仑后不做处理，等待自然清醒。观察并记录2组的意识恢复时间、喉罩拔除时间和麻醉后监测治疗室（PACU）停留时间；记录2组术毕停药时(T0)、意识恢复时(T1)、拔喉罩时(T2)和拔喉罩后（T3）各时点的平均动脉压(MAP)、心率、脉搏血氧饱和度（SpO2）和脑电双频指数（BIS）；观察2组喉罩拔除后和PACU期间不良反应的发生情况。结果  氟马西尼组意识恢复时间、喉罩拔除时间和PACU停留时间均短于对照组［（4.8±2.1）min比（8.5±3.6）min、（5.9±2.0）min比（9.5±3.9）min、（33.9±2.6）min比（35.3±2.1）min］，差异均有统计学意义（均P＜0.05）。2组各时点MAP、心率和SpO2比较，差异均无统计学意义（均P＞0.05）。2组T0~T2时点BIS比较，差异均无统计学意义（均P＞0.05）；氟马西尼组T3时点BIS高于对照组，差异有统计学意义（P＜0.05）。喉罩拔除后和PACU期间，氟马西尼组与对照组嗜睡、头晕、烦躁和恶心呕吐的发生率比较差异均无统计学意义（均P=1.000）。结论  氟马西尼用于拮抗瑞马唑仑全身麻醉术后残余镇静作用，可以明显缩短患者的苏醒时间，不增加不良反应的基础上提高了麻醉的可控性。

• Objective  To observe the efficacy and safety of flumazenil on antagonizing the residual sedative effect of remimazolam after ophthalmology and otorhinolaryngology surgery under laryngeal mask general anesthesia. Methods  From July 2021 to July 2022, totally 80 patients were enrolled from Beijing Tongren Hospital, Capital Medical University. Patients underwent surgeries of ophthalmology(vitrectomy), otology(tympanoplasty) and laryngology(endoscopic sinus surgery) under laryngeal mask general anesthesia. They were divided into flumazenil group and control group according to random number table method, with 40 cases in each group. Laryngeal mask general anesthesia induced and maintained by remimazolam was used in both groups. In the flumazenil group, flumazenil was injected intravenously after the discontinuation of remimazolam at the end of operation, and the control group did not do any treatment and waited for natural recovery. The consciousness recovery time, laryngeal mask extubation time and postanesthesia care unit(PACU) residence time were observed and recorded; the mean arterial pressure(MAP), heart rate, pulse oxygen saturation(SpO2) and bispectral index(BIS) of the two groups were recorded at the time of drug withdrawal at the end of operation(T0), consciousness recovery(T1), laryngeal mask extubating(T2) and after laryngeal mask extubation(T3); the incidence of adverse reactions in the two groups were observed after laryngeal mask extubation and during PACU. Results  The consciousness recovery time, laryngeal mask extubation time and PACU residence time in the flumazenil group were shorter than those in the control group［（4.8±2.1）min vs （8.5±3.6）min,（5.9±2.0）min vs （9.5±3.9）min,（33.9±2.6）min vs （35.3±2.1）min］(all P<0.05). There were no significant differences in MAP, heart rate and SpO2 between the two groups at each time point(all P>0.05). There were no significant differences in BIS between the two groups at T0-T2 time points (all P>0.05); BIS in the flumazenil group was higher than that in the control group at T3 time point(P<0.05). There were no significant differences in the incidences of lethargy, dizziness, irritability, nausea and vomiting between the two groups after laryngeal mask extubation and during PACU(all P=1.000). Conclusion  Flumazenil can significantly shorten the awakening time of patients and improve the controllability of anesthesia without increasing adverse reactions used for antagonizing the residual sedative effect of remimazolam after surgery.